Surgical retractor having improved blades

ABSTRACT

The present invention relates to surgical retractors having improved blades for use, on the retractor and devices for stabilizing a predetermined area of the body during a surgical procedure, more particularly to surgical retractors and stabilizing devices used in connection with minimally invasive coronary artery bypass grafting surgical procedures, and more specifically to surgical retractors and stabilizing devices especially configured for use with each other for such surgical procedures wherein the retractor includes a plurality of grooves on the bottom surface thereof and a plurality of blades having a member that is releasably received in the grooves and which also allows for the pivotal movement of the blades relative to the arms of the retractor and further including nesting blades having a third section which is generally linear and second sections which are preferably curved about 180 degrees to allow for the simplified insertion of the blades into the chest incision and the providing for the secure and stable positioning of the retractor relative to the chest of the patient.

RELATED APPLICATION

The present application is a continuation-in-part of U.S. Ser. No.09/345,859 filed on Jul. 1, 1999 U.S. Pat. No. 6,348,036 and U.S. Ser.No. 60/117,333 filed on Jan. 24, 1999, all of which are commonlyassigned. The priority of each application is claimed hereby.

FIELD OF INVENTION

The present invention relates to surgical retractors and devices forstabilizing a predetermined area of the body during a surgicalprocedure, more particularly to surgical retractors and stabilizingdevices used in connection with minimally invasive coronary arterybypass grafting surgical procedures, and more specifically to surgicalretractors are stabilizing devices especially configured for use witheach other for such surgical procedures.

BACKGROUND OF THE INVENTION

Diseases of the cardiovascular system affect million s of people eachyear and are a cause of death for large numbers of people in the UnitedStates and throughout the world. A particularly prevalent form ofcardiovascular disease involves a reduction in the blood supply to theheart caused by atherosclerosis (coronary artery disease) or otherconditions that create a restriction in blood flow at a critical pointin the cardiovascular system leading to the heart.

One technique for treating such a blockage or restriction is a surgicalprocedure known as a coronary artery bypass graft procedure, which ismore commonly known as “a heart bypass” operation. The surgicalcorrection of occluded or stenosed coronary arteries by means of bypassgrafting are probably still the most common procedures performed today,especially when multiple grafts are needed.

In the coronary artery bypass graft procedure, the surgeon eitherremoves a portion of a vein from another part of the body for graftingor detaches one end of an artery and connects that end past theobstruction while leaving the other end attached to the arterial supply.When using a vein from another part of the body, the surgeon installsthis portion at points that bypass the obstruction. In both cases, theobjective is to restore normal blood flow to the heart.

In addition, when using this technique the surgeon makes a long incisiondown the middle of the chest, saws through the sternum, spreads the twohalves of the sternum apart using either curved or straight blades. Thecurved blades are commonly known as “Cooley” style blades. The curvedblades are preferred by many surgeons because they provide the surgeonwith better stabilization of the retractor in the chest incision becausethe sternum is captured within the curvature of the blade. The problemwith these types of blades is that they are more difficult to insertbecause they have a larger side profile. The other type of commonly usedblades are the straight blades. These are generally known as“Finochietto” style blades. The straight blades are preferred by manysurgeons because they have a low side profile and are easy to insertinto the chest incision. The difficulty with the straight blades is thatthey offer the surgeon less stabilization of the retractor in the chestincision than the curved blades. Once the blades of the retractor areinserted, the surgeon may then perform the procedures necessary toconnect the surgical patient to a cardiopulmonary bypass machine tocontinue the circulation of oxygenated blood to the rest of the bodywhile the heart is stopped and the graft is being sewn in place althoughsuch a procedure is one common technique for treatment, the procedure islengthy, traumatic, considerably expensive and can damage the heart, thecentral nervous system and the blood supply.

In recent years, and in an effort to reduce expense, risk and trauma tothe patient, physicians have turned to less invasive surgical approachesto the heart, such as intercostal and endoscopic access to the surgicalsite. With such procedures, the heart is beating during the surgicalprocedure. Thus, there is no need for any form of cardiopulmonary bypassand there is no need to perform the extensive surgical proceduresnecessary to connect the patient to such a bypass machine.

Such attempts at performing minimally invasive bypass grafting on abeating heart, however, have been thought of as being tedious, dangerousand difficult because of the delicate nature of the surgical procedure,the lack of adequate access through a reduced surgical field, and thelack of a way to adequately stabilize and reduce tissue movement at thegraft site. Because these procedures are performed while the heartmuscle is continuing to beat, the blood continues to flow and the heartcontinues to move in three dimensional movement while the surgeon isattempting to sew the graft in place. Also, the surgical procedure toinstall the graft requires placing a series of sutures through anextremely small vessel and onto tissue that continues to move during theprocedure. It is necessary that these sutures be fully and securelyplaced so the graft is firmly in position and does not leak.

There is disclosed in U.S. Pat. No. 5,730,757, an access platform forthe dissection of an internal mammary artery. The described accessplatform has first and second blades interconnected to a spreader memberthat laterally drives the blades apart together and support padsinterconnected to the first blade. A torsional member is operablyinterconnected to the first blade and the spreader member and is used tovertically displace the first blade in either direction. Thus,increasing the surgeon's working space and visual access for thedissection of the internal mammary artery. A tissue retractorinterconnected to the blades is used to draw the soft tissue around theincision away from the surgeon's work area. It is further provided thatthe access platform can include a port that can be used to mount a heartstabilizer instrument. In U.S. Pat. No. 2,450,194 granted to Glaser, anadjustable retractor is disclosed. This retractor includes movable bladestructures on each retractor arm wherein the blades include tubularsleeves that include a set screw to hold the blades in a fixed positionrelative to the retractor arms.

There also is described in U.S. Pat. No. 5,875,782 granted to Ferrari etal. and U.S. Pat. No. 5,894,843 granted to Benetti et al. an apparatusfor stabilizing the predetermined area on a heart or other organ of apatient to enable a surgical procedure on a beating heart. The apparatusincludes a bifircated member having two elongated prongs and anelongated handle. The handle segment can be movably attached to a ribretractor so that a person is not required to hold the handle segment.In one disclosed embodiment, the apparatus further includes a device tohold the bifurcated member in a position against the surface of theheart sufficiently so that a stabilizing force is applied against theheart and contraction of the heart does not cause either vertical orhorizontal motion at the target site during the surgical procedure.

There also is described in U.S. Pat. No. 5,836,311 granted to Borst etal. an apparatus for stabilizing the predetermined area on a heart orother organ of a patient to enable a surgical procedure on a beatingheart. The apparatus includes a single legged or bifurcated memberhaving a plurality of suction members thereon which are attached to thesurface of the heart using suction pressure. The arm portion of thisdevice can be movably attached to a rib retractor or other surgicaldevice so a person is not required to hold the handle segment and thesuction device may be locked into position against the surface of theheart

It is therefore desirable to provide a new system and devices relatedthereto for stabilizing a predetermined area of the body, such as theheart and methods related thereto. It is particularly desirable toprovide such a system and devices thereto that are less complex and moreuser friendly in comparison to prior art devices. Such systems anddevices thereto preferably are simple in construction and less costlythan prior art devices.

SUMMARY OF THE INVENTION

The present invention features improved retractor blades for use on asurgical retractor and an improved system for retracting, stabilizing ormanipulating a predetermined area of a body. The overall system includesa surgical retractor, a stabilization arm or apparatus and a tissuesupport or stabilization device, and methods of use related thereto.Also featured is a system that supports any of a number of surgicalimplements, for example a diaphragm retractor, a valve retractor, alight or suction device for use during a surgical procedure. Thestabilization system and related devices and apparatuses thereto thatare featured herein are particularly advantageous for use in performingoff-pump coronary artery bypass grafting procedures in which the heartremains beating during the surgical procedure or in valve replacementprocedures.

One advantage of the present invention relates to the use of theimproved blades to provide blades that may be nested together and areeasier to insert into the chest incision of the patient while providingstable retention of the sternum of the patient during the procedure.

A further advantage of the present invention relates to the use of theimproved blades that are preferably pivotal relative to the retractorarms provide blades that are easier to insert into the chest incision ofthe patient while providing stable retention of the sternum of thepatient during the procedure.

A further advantage of the present invention relates to the use of theexternal rail system on the arms of the retractor and even morepreferably also on the rack segment of the retractor. The use of theexternal rail systems allows the stabilization arm to be attached to theretractor at any desired location and does not require that thestabilization arm be slid on from an end of an arm or specially attachedin certain specific locations. Additionally, the sled of the presentinvention allows for a full range of motion which is controlled by asingle knob that is easily manipulated by the surgeon.

The present invention features a surgical retractor including two arms,a rack segment and a plurality of sternal blades with at least one bladeextending downwardly from each arm. Each blade includes an upper sectionadjacent to the bottom surface of the arm and a lower section extendingdistally of the arm. A slot on the bottom surface of the arms includes atapered surface adjacent to the front edge thereof to facilitate theplacement of the blades on the arms. A lip surface is also locatedadjacent to the slots on the bottom surface of the arms to securelyretain the blades on the bottom surface of the arms during the procedurewhile still allowing the blades to be easily removable for initialpositioning and subsequent sterilization following the procedure.

In a further embodiment of the present invention, the blades areconfigured with a straight surface along the bottom portion and a curvedsurface along the upper portion to allow the blades to be aligned duringthe initial insertion step while also capturing the tissue adjacent tothe sternum of the patient with the curved portion once the blades arefully inserted into the chest incision.

In a general aspect, the stabilization system of the present inventionis preferably used for stabilizing a predetermined area of a patient.This system preferably includes a retractor, a stabilization device forlocally stabilizing the predetermined area and a stabilization arm thatfunctionally secures the stabilization device to the retractor. Theretractor preferably includes a rail system having two arms and a racksegment. The rack segment interconnects the two arms, for selectivelyspacing the two arms from each other and for maintaining the two arms ina desired fixed relationship. In a preferred form of the presentinvention, the two arms and rack segment are configured to receive theconnector of the stabilization arm at the desired location thereon.

The stabilization device preferably includes a device of the typecommonly known as the Cohn Cardiac Stabilizer marketed by the GenzymeCorporation of Cambridge Massachusetts, although horseshoe or suctiontype devices may also be used. The preferred form of the stabilizationdevice is a generally square or rectangularly shaped member having aplanar surface with centrally located opening therein. This opening isthe area through which the surgeon performs the anastomosis or otherprocedure on the tissue of the beating heart. The stabilization deviceis preferably a two piece member so that once the anastomosis iscompleted, the pieces may be separated to remove the device from aroundthe anastomosis. As described more fully below, flexible tapes aresutured through the tissue and then threaded through the stabilizingdevice. Once the stabilization device is positioned in the desiredorientation and location in contact with the tissue, the flexible tapesare then pulled snug through the opening of the stabilization device toprovide a system which minimizes the overall movement of thepredetermined area of the tissue.

The stabilization arm preferably includes an elongated handle having afirst end and a connector thereon for releasably connecting thestabilization device to the elongated handle first end. This connectionallows the stabilization device to be pivotally and slidably moved to adesired position into contact with the predetermined area of the tissueof the patient. The stabilization arm also includes a mounting mechanismor sled member which is preferably slidable along the handle segment forremovably securing the stabilization arm to at least one of the rails onthe retractor arms and/or the rack segment of the retractor.

According to another aspect of the present invention, the arms of theretractor are configured with a front edge and a step in the top surfacethereof to form an elongated rail surface along substantially the entirelength thereof. The step is preferably spaced apart a predetermined andconsistent distance from the front edge and is also located on theinterconnecting or rack segment of the retractor. Also, thestabilization arm preferably includes a mounting mechanism or sledmember which is configured to removably engage the front edge and thestep at any desired location on one or more of the arms or the racksegment of the retractor. The mounting mechanism includes a lever forselectively engaging the step and front edge on the arm or rack segmentof the retractor so the mounting mechanism is removably and slidablysecured to the arms or the rack segment.

In yet another aspect of the present invention there is featured a sledmember or mounting mechanism that allows the user to retain thestabilization arm in a sliding and fixed relationship relative to theretractor and patient while also allowing for the rotation of the sledmember with respect to the retractor by manipulating a single knob.Furthermore, a lever on a bottom section of the sled member allows thesled member to be slidably and fixedly positioned along the arms andrack segment of the retractor. Each of these features enables the userto determine the optimum position for the stabilization arm andstabilization device while ensuring that the surgeon's view of theoperative area is not unnecessarily obstructed. Additionally, thesefeatures allow the present invention to be used in many differentmedical procedures because of the versatility of system set up andorientation of the components of this invention.

Other aspects and embodiments of the invention are more fully discussedbelow.

BRIEF DESCRIPTION OF THE DRAWINGS

For a fuller understanding of the nature and desired objects of thepresent invention, reference is made to the following detaileddescription taken in conjunction with the accompanying drawing figureswherein like reference numbers denote corresponding parts throughout theseveral views and wherein:

FIG. 1 is a perspective view of a stabilization system that assists inthe stabilization of a predetermined area of a body according to a firstaspect of the present invention with the handle removed for clarity;

FIG. 2 is a perspective view of the stabilization system of the presentinvention with the handle removed for clarity and wherein the sledmember is positioned on a rack segment of the retractor;

FIGS. 3A and 3B are bottom perspective and bottom isometric views of thestabilization system of FIG. 1;

FIG. 4 is a cross sectional view of the rack segment taken generallyalong lines 4—4 of FIG. 1;

FIG. 5 is a cross sectional view of the arm section taken generallyalong lines 5—5 of FIG. 1;

FIGS. 6A, 6B and 6C various elevational views of the stabilization armand stabilization device of the present invention;

FIG. 7 is a cross-sectional view of the upper section of the sled memberof the stabilization an of the present invention taken generally alonglines 7—7 of FIG. 6A;

FIG. 8 is a side view of the bottom section of the sled member of thestabilization arm of the present invention;

FIG. 9 is a bottom view of the bottom section of the sled member of thestabilization arm of the present invention;

FIG. 10 bottom view of the retractor of the present invention with theblades removed;

FIG. 11 is an end view of the retractor of the present invention withthe blades thereon;

FIG. 12 is a cross sectional view taken generally along lines 12-12 ofFIG. 3 with the blade inserted in the ridged slot of the arm;

FIGS. 13A and 13B is a top and bottom perspective views of the blademember of the present invention,

FIG. 14 is a top perspective view of an alternate form of the blademembers of the present invention;

FIG. 15 is a top elevated perspective view of the alternate form of theblade members of the present invention shown in FIG. 14; and

FIGS. 16A, 16B and 16C bottom and side perspective views of thealternate form of the blade members attach d to the surgical retractorwith the surgical retractor in the closed and open positions.

DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring now to the various figures of the drawings wherein likereference characters refer to like elements, there is shown variousviews of a preferred and alternate form of a stabilization system 100according to the present invention for contributing to the stabilizationof a predetermined area of a body such as the predetermined area of aheart or other organ of a patient to enable the physician to perform asurgical operation or procedure on a patient. The stabilization system100 is particularly useful in connection with single or multiple vesseloff-pump coronary artery bypass surgery on a beating heart through asternotomy or mini-sternotomy incision.

A surgeon may use the stabilization system 100 to apply a slightcontacting or compressive force on the heart in the area where thesurgical procedure will occur so the heart's movement at that specificarea is diminished. In a preferred form of this invention, thestabilization system 100 is used in combination with flexible tapes orsutures or other mechanical means so that the surface of the heart isstabilized using a combination of restraining and stabilizing forces. Incertain procedures, it may also be advantageous to place a tractionsuture around an artery using a needle and suture thread to occlude theblood vessel. These sutures may then be attached to the stabilizingdevice so that the flow of blood through the blood vessel is selectivelyrestricted.

Systems for stabilizing the heart of a patient are particularly usefulfor various heart suturing techniques or procedures. One example of thistype of procedure is the performance of an anastomosis for a bypassgraft. In this type of procedure, the physician is attempting to suturethe circumference of a blood vessel that may be about 1 mm to a movingblood vessel on the surface of the heart. Another area of use of thepresent invention may be in brain surgery, heart valve surgery or othertypes of blood vessel surgery where stability is critically important toavoid disastrous consequences or where it is desirable to have aprecisely defined and stable surgical field. One skilled in the art willappreciate that the present invention, although advantageously suitedfor heart surgery, can be used at any location on or within the bodywhere tissue stabilization or isolation of a predetermined area isdesired. This includes, but is not limited to, the liver, kidneys,bladder, stomach, intestines, brain and vascular and other soft tissuesurgery. Additionally, one skilled in the art will appreciate, ashereinafter described, that the supporting components of the system canbe adapted so that any surgical instrument or device can beself-supported during a surgical procedure.

Referring specifically to FIGS. 1-4, the stabilization system 100according to the present invention includes a retractor 102, astabilization sub-system or stabilization arm 104 and a stabilizationdevice 106. The retractor 102 is specifically configured so thestabilization arm 104 can be secured thereto. The retractor 102,preferably includes a rigid L-shaped member 110 having an arm segment112 and a rack segment 114. The retractor 102 also includes a movablesecond arm segment 116 having a handle 118 thereon which is movablyassociated with the L-shaped member 110.

The stabilization arm or sub-system 104 preferably includes an elongatehandle segment 180 that preferably interconnects the retractor 102 andthe stabilization device 106. The handle segment 180 preferably includesa first end having a distal connector 181 thereon to pivotally andremovably retain the stabilization device 106 thereon. The handlesegment 180 is attachable to the retractor 102 by a connector such as amounting mechanism or sled member 140. The proximal or second end of thehandle segment 180 preferably includes a knob 184 thereon that isrotatable with respect to the handle segment 180 to allow the movementof the stabilization device 106 to be pivotal and/or fixed with respectto the handle segment 180 by manipulating the knob 184 on the proximalend of the handle segment 180. This arrangement also allows thestabilization device 106 to be mountable on and removable from thedistal connector 181.

The preferred form of the stabilization device 106 is generally arectangular shape having an opening or window area 190 therein. Thestabilization device 106 preferably includes a first surface 192 that isgenerally planar and may include a textured surface thereon tofacilitate the engagement between the stabilization device and thetissue of the predetermined area or the heart of the patient. The secondsurface 194 of the stabilization device 106 preferably includes a postmember 196 extending therefrom. The post member 196 is preferablyreleasably and rotatably engaged by the distal connector 181 on thefirst end of the handle segment 180.

As described briefly above, the retractor 102 preferably includes ahandle 118 located on the second arm segment 116 and the handle 118 isrotatable for displacing the two arm segments 112,116 with respect toeach other. In the preferred form of this invention, rotation of thehandle 118 causes a pair of posts or pinions 119 to sequentially engagethe teeth 115 located on the outer edge 121 b of the rack segment 114 toincrease or decrease the distance between the first and second arms 112and 116. As shown, the handle includes a projection 177 on the bottomsurface thereof which fits in a slot located in the retractor adjacentto the arm and rack segment to allow the user to lock the handle intoposition once the arms are in the desired position. This feature isparticularly useful where the retractor is reused for a relatively longperiod of time for multiple procedures because the pinions and teeth onthe retractor will gradually wear due to the pressure from the chest ofthe patient. As the wear occurs, the pressure from the sternum may causethe arms to move towards each other unless the arms or handle areretained in a locked position. In a specific illustrative embodiment,the rack segment 114 is configured with a finochetti type of rack as isknown to those skilled in the art. In conjunction with the handle 118,the rack segment 114 and movable second arm 116 form a rack and piniontype of means for displacing the arm segments 112, 116 with respect toeach other. As shown, this type of rack segment 114 includes a pluralityof laterally extending teeth members 115 that engage the posts 119 orsimilar tooth engaging members located in operative contact with thehandle 118 of the second arm segment 116. It is anticipated that avariety of mechanisms may be used to move the second arm segment 116along the rack segment 114. For example, a gear mechanism, a slide andlocking mechanism or similar arrangement may be used to accomplish theseparation and fixation of the second arm 116 with respect to the firstarm 112. It is within the scope of the present invention, however, forthe retractor 102 to be configured or designed with any of a number ofmeans known to those skilled in the art for selectively displacing thefirst and second arm segments, 112 and 116 either towards or away fromeach other in a parallel, obtuse or acute angled manner.

At least one arm segment and preferably each arm segment, 112 and 116respectively, and the rack segment 114 are configured so as to each havea front edge surface 120 a, 120 b and 120 c extending along the innersurface of each element of the retractor 102 such that the front edgesof each of the arms and the rack segment face each other. The retractor102 also preferably includes an outer edge surface 121 a, 121 b and 121c extending along the outer surface of the first and second arms, 112and 116 respectively, of the retractor 102. A step surface 122 a, 122 band 122 c extends along the top surface of the first and second arms,112 and 116 respectively, and the rack segment 114 in a spaced apartrelationship with respect to the front edges of each of the surfaces ofthe first and second arms and the rack segment to form an elongate lipor external rail surface on the arms and rack segment of the retractor.The step surface 122 a-c is preferably located a preset distance backfrom the front edge and forms an acute angle facing away from the frontedge thereof on each of the arms and the rack segment. As describedhereinafter, the front edge surfaces 120 a-c and the step surfaces 122a-c on the top surface of the arms and rack segment are particularlyarranged and configured to face each other and so that the mountingmechanism or sled member 140 can be readily secured to the retractor 102by engaging the front edge surface (120 a, 120 b or 120 c) and theassociated step surface (122 a, 122 b or 122 c) on each of the first andsecond arms, 112 and 116, and the rack segment 114.

As also shown in the top views of the preferred form of the presentinvention, the front edge surfaces 120 a and 120 c of the first andsecond arm segments that are adjacent to the step surfaces 122 a and 122c are of a preferably slightly concave orientation such that the midpoint of the first and second arms are spaced apart from each other agreater distance than the distance of either or both of the inner orouter ends of the first and second arms, 112 and 116. Additionally, theouter edge surfaces 121 a and 121 c of each arm preferably has a greatercurvature than the front edge surfaces 120 a and 120 c of the same armso that as the retractor 102 spreads the chest of the patient, themotion of separating the first and second arms, 112 and 116, isemphasized to increase the amount the chest of the patient is spread.Therefore, at a given distance of separation between the first andsecond arms, 112 and 116, the midpoints of the outer surface of the armswill be separated a further distance than at the ends adjacent to therack segment or at the ends furthest from the rack segment 114 due tothe overall generally clam shell shaped configuration of the preferredform of the present invention. An advantage of this configuration isthat the surgeon is provided with an opening in the sternum of thepatient that is wider in the center than along the edges so that themost common area of work for the surgeon is larger than a conventionalretractor for the same amount of separation.

Additionally, as shown in the drawings, the top surface of each of thearms, 112 and 116, preferably include a plurality of slots 123 extendinggenerally perpendicular to the lengthwise dimension of each arm. Theseslots 123 extend from the front edge surfaces 120 a and 120 c; throughthe step surfaces 122 a and 122 c; and to the outer edge surfaces 121 aand 121 c, respectively on each of the first and second arms, 112 and116. These slots 123 are configured to extend through the front edgesurface 120 a and 120 c of each arm, 112 and 116, to allow the sledmember 140 to be moved therealong while not cutting or interfering withany sutures that may be positioned in the slots. Additionally, each ofthe slots 123 preferably include a through hole 124 in communicationwith the slot and extending through the arm. In the preferred use of thepresent invention, the slots 123 are preferably used to position suturesthat have been threaded through the pericardium of the patient thereinso that the pericardium or other tissue is retracted and held out of theline of sight of the surgeon by the sutures to better expose the heartof the patient. With the preferred form of the present invention, thesutures and clamps are retained out of the working area of the surgeon.The portion of the through hole 124 adjacent to the top and bottomsurfaces of the arm are preferably tapered so that distal end of theclamps or other instruments that are used to hold the sutures may beplaced and retained therein during the procedure. By allowing the distalends of the instruments to be placed into the through holes 124, thesutures are held in a secure position during the procedure and may beadjusted as needed at any time by lifting the instrument and thenreclamping the suture or releasing the clamp and then pulling the suturethrough the clamp and subsequently closing the clamp while it remains inthe through hold. Additionally, it is anticipated that some surgeons mayuse these through holes to suture the retractor to the patient tominimize possible extraneous movement of the retractor during theprocedure.

In an exemplary embodiment of the present invention, the bottom surfaceof each of the first and second arms, 112 and 116, on the retractor 102include removable sternal blades 130 attached thereto. Each blade 130 isremovable so as to facilitate the use of the retractor in a full ormini-sternotomy procedure by allowing for the selective positioning andspacing of the blades 130 as desired for the particular procedure aswell as for resterilization of the retractor 102 and blades 130. Asillustrated, the blades 130 are positioned along the bottom surface ofthe arms 112 and 116 and are preferably pivotal in the horizontal andvertical directions with respect to the arms. In a preferred form of thepresent invention, the blades 130 are pivotal in the horizontaldirection of about thirty degrees and are slightly pivotal in thevertical direction. The blades 130 are slidable into elongate ridgedslots 132 on the bottom surface of the first and second arms, 112 and116. The blades 130 may swivel a limited distance and are selectivelypositioned in the slots 132 so as to evenly distribute the retractionforces or pressure along the contour of the sternum of the patient. Anupper section 134 of each blade 130 is particularly configured tofacilitate the insertion of the blades into the retractor. Inparticular, the upper section 134 of the blade 130 is configured so thatan upward extending and generally oblong shaped lip member 136 isreceived in the ridged slots 132 located on the bottom surface of thefirst and second arms, 112 and 116. This surface further includes araised ball member 137 which slides in a further slot 139 located in theridged slots. The ball member may be slightly depressible so that it maybe slid beyond the further slot 139 so that during the initial placementof the retractor, the blades may be positioned to extend nearly linearlyalong each arm in an insertion position. As the arms are retracted, theinner and outermost blades move to a retraction position to assume aslightly curved shape. In the preferred form of the present invention,the retraction position generally approximates the anatomy of thepatient and allows the pressure of the sternum of the patient to beevenly distributed among the blades. The use of the ball member and thefurther slots and the ridged slots allow the blades to temporarilyassume the linear configuration and also rise slightly to provide alower profile and maintain the retraction edge. Once the blades areinserted into the sternum, the slight release of the pressure during theinsertion allows the ball member to return to the innermost end of thefurther slot. In the present invention, the blades preferably follow theslightly curved shape of the retraction position and provide optimumleverage to retract the sternum of the patient. The upper section 134 ofthe blade 130 extends generally along the bottom surface of the firstand second arms, 112 and 116 and is positioned so the blade 130 extendsa short distance inwardly of the front edge surfaces 120a and 120c ofthe arms 112 and 116. The blades 130 also include a lower section 138which extends downwardly from the upper section 134 of the blade 130 ina curved manner to extend beneath the bottom surface of the retractor toreadily engage the sternum of the patient. The lower section alsopreferably curves backward a short distance towards the outer edgesurface 121 of the first and second arms, 112 and 116, to form a blade130 having an overall C or L shape that facilitates the positioning andretention of the sternum of the patient adjacent thereto. Therefore, theblades 130 in conjunction with the displacement of the first and secondarms result in the desired retraction of the tissue, bone etc. for thesurgical procedure. Although the blades are shown as being receivable inthe ridged slots 132, it is anticipated that the blades 130 of thepresent invention may also be received in slots or similar structures onthe arms of the retractors.

The stabilization sub-system or stabilization arm 104 of the presentinvention preferably includes an elongate handle segment 180 thatinteracts with the retractor 102 and the stabilization device 106. Thehandle segment 180 is preferably a rigid tubular member that includes adistal connector 181 on the distal end thereof to pivotally andremovably retain the stabilization device 106 thereon. The handlesegment 180 is attachable to the retractor 102 by a connector such as amounting mechanism or sled member 140. The proximal end of the handlesegment 180 preferably includes a movable knob 184 and a fixed knob 186thereon. The movable knob 184 is connected to an elongate rod that isthreaded through the handle segment 180 and extends to the distalconnector 181. The fixed knob 186 is fixed proximally of the movableknob 184 on the handle segment 180 to allow the user to rotate thestabilization device 106 by manipulating this fixed knob 186 when thestabilization device 106 is connected to the distal connector 181 of thehandle segment 180.

As illustrated, the distal connector 181 consists of a generally bulbousmember having an elongate slot 187 extending through at least one sidethereof. The slot 187 is sized to allow the post member 196 of thestabilization device 106 to pass laterally therethrough to allow thestabilization device to be easily mounted on or removed from thestabilization arm 104. Additionally, the use of the bulbous shape on thepost member 196 and the complementary shape of the slot 187 allows thestabilization device to be pivotal and rotatable about the handlesegment to enable the surgeon to position the stabilization device 106in the desired position and against nearly any surface of the heart ofthe patient. The stabilization device 106 is fixed in the desiredposition relative to the handle segment 180 by rotating the movable knob184 with respect to the handle segment and/or the fixed knob so that aportion of the elongate rod moves with respect to the outer surface ofthe handle segment 180 and extends into the distal connector 181 tocontact and engage the post member 196 of the stabilization device 104.This movement of the elongate rod with respect to the distal connectorcauses the post member to press against the lower lip surfaces 189 ofthe distal connector. The preferred, generally pear-like, shape of thedistal connector 181 optimizes the connection between the distalconnector 181 and the post member 196 to enable the stabilization device106 to be selectively retained within the distal connector 181 whileallowing for the pivotal and rotational movement necessary for the useof this device in a cardiac application where space is at a premium andthe device must be as versatile as possible to accommodate the surgeonsneeds without undue experimentation.

The stabilization arm 104 of the preferred embodiment also includes asled member 140 operatively connected thereto. The sled member 140 isconfigured so the surgeon has multiple axis positioning capability forthe stabilization device 106 while requiring a minimum of manipulation.In an exemplary embodiment, the bottom section of the sled member 140includes a front edge lip 150, a movable second lip 152 and an actuatorlever 154. The actuator lever 154 is pivotally connected to an elongateslot in the second lip 152 by a pin 158 which is preferably offset withrespect to the axis of rotation of the actuator lever 154 so thatmovement of the actuator lever 154 causes the second lip 152 to movetowards and away from the front edge lip 150. The front edge lip 150 isconfigured so that the interior of this lip conforms generally to theshape and configuration of any of the retractor front edge surfaces 120a-c. The front edge lip 150 also includes a portion that extendsbackwards under the front edge surfaces 120 a-c of the arms and/or racksegment of the retractor so the front edge lip 150 preferably forms anacutely angled surface that is easily secured at any location on any ofthe front edge surfaces 120 a, 120 b or 120 c of the retractor 102.

As also shown in the drawings, the second lip 152 of the sled member 140is a semicircular or oblong shaped member that is disposed in the bottomof the sled member 140 a distance back from the front edge lip toselectively engage the recessed side of any of the step surfaces 122 a-cof the retractor. The second lip 152 also is generally configured so theinside interior surface 151 of the sled member 140 extends arcuatelyacross and lies upon the top surface of the retractor 102 between afront edge surface 120 a-c and the associated step surface 122 a-c ofthe retractor. The second lip 152 is slidably mounted on the bottom sideof the sled member 140 and is movable in response to rotation of theactuator lever 154 to form an acute step surface engaging angle betweenthe sled second lip 152 and the inside interior surface 151 to securelyretain the selected step surface 120 a, 120 b or 120 c therein.

One skilled in the art would recognize that there are a number of meansavailable in the art for removably securing the sled member 140 to thefront edge surface and step surface 122 a-c of the retractor. Forexample a wing nut or similar threaded type of arrangement where thewing nut would act on the vertical surface of the retractor step may beused. However, the use of the actuator lever 154 of the preferredembodiment provides the surgeon with a quick and simple means forattaching the sled member 140 to any desired location on the retractor102 with a single handed operation of the actuator lever 154.Additionally, the distance of travel of the actuator lever 154 is chosenso as to be preferably less than about 180 degrees to further facilitatethe single handed attachment of the sled member 140 to the retractor102. Additionally, the actuator lever 154 is preferably positioned onthe side of the sled member 140 which is adjacent to the outer edgesurface 121 a-c of the retractor 102 so as to not interfere. with theoperative field or vision of the surgeon.

In an alternate embodiment, a cam shaped member may be located on thebottom surface of the sled member instead of the second lip 152described above. The cam shaped member may be formed as a generallycircular member that is configured with a flat region on at least onepart of the circumference. To place the sled member onto the retractorof this embodiment, the actuator lever may be rotated so that cam isrotated and the flat side of the cam faces the sled front edge lip.After the sled member is placed on the retractor, the actuator lever isagain rotated so the curved portion of the cam will come into contactwith and engage the vertical surface of the retractor steps.

As indicated above, rotation of the cam may be accomplished by rotationof the actuator lever and the actuator lever is movable between variouspositions wherein the cam is fully contacting, partially contacting orspaced apart from the top surface and step of the retractor. It iswithin the scope of the present invention, however, for the cam to bespring loaded such that the cam automatically rotates so the curvedportion of the cam contacts the retractor step when the actuator leveris not being held by the surgeon. In other words, the cam may be biasedso that the curved portion of the cam faces the sled front edge lip.

It is within the scope of the present invention for the cam or secondlip to have any geometric configuration or shape consistent with thepreferred features of the present invention, for example, some of thesepreferred features relate to the ease and versatility of removablymounting the sled member 140 onto and removing the sled member from theretractor 102. For example, directly mounting and directly removing thesled without being required to slide the sled member on and off the endsof the arms of the retractor 102 as well as for providing the ability tomount the sled member 140 onto the rack segment 114 of the retractor.Furthermore, the ability to mount the sled member 140 on any one of thearms and rack segment on a temporary basis and then being able to slidethe sled member into the final desired position is an advantage over thecurrently available retractors. This is particularly true in thepreferred form of the present invention where, in the midway position ofthe actuator, the actuator lever will cause the retention of the sledmember on the retractor while allowing sliding movement therebetween.The actuator lever may then be moved to the engaged position to lock thesled member and therefore, the stabilization arm in the desired positionon the retractor.

In the preferred embodiment of the present invention, the sled member140 also includes an upper section including a knob 160, a stabilizationarm clamp 162, a sled pin clamp 166, and a threaded rod 170 therein.This portion of the sled member 140 provides the surgeon with therotational movement of the stabilization arm 104 in a combination ofhorizontal and vertical directions as well as allowing for the slidingand rotational movement of the handle segment 180 therethrough, all ofwhich are advantageously controlled by the operation of the single knob160 that is located along the periphery of the operative field

The sled pin 158 extends upwardly from the portion of the bottom sectionof the sled member 140 to form a first or vertical axis of rotationbetween the bottom section that includes the front edge lip 150, secondlip 152 and the actuator lever 154 described above and the upper sectiondescribed below. This arrangement enables the bottom section of the sledmember to be rotatable with respect to the upper section of the sledmember 140 independently of whether or not the sled member is lockedinto position along the arms and/or rack segment of the retractor.Additionally, this orientation places the upper section of the sledmember preferably directly above the front edge of the retractor asshown. This orientation significantly increases the range of motion ofthe sled member and therefore the range of motion of the stabilizationarm and ultimately significantly increases the versatility and range ofmotion of the stabilization device. For example, rotation of the sledmember 140 and stabilization arm 104 will allow the user to position thestabilization device 106 beneath the arms and/or rack segment byallowing the aperture 164 which contains the handle segment 164 toextend inwardly of the front edge 120 of the retractor 102. Thisorientation is particularly useful in situations where the posteriorsurface of the heart is being operated on as well as in certainsituations where the selected portion of the heart is manipulated to aside of the operative field. This type of orientation may require thehandle segment to be oriented at an angle which is generally greaterthan perpendicular to the width dimension of the arms or rack segment.Alternately, the sled pin may be angled to cause the upper section ofthe sled member to extend inwardly of the front edges of the arms andrack segment to further increase the versatility of the presentinvention. The sled pin 158 is rotatably received in a recess or pocket168 that is formed in left and right sections of the sled pin clamp 166on the sled member 140. In this way, and as described hereinafter, theupper section of the sled member 140 can be rotated by the surgeon aboutthe sled pin 158 to facilitate the rotational positioning of thestabilization arm 104 and stabilization device 106 at the desiredpredetermined area on the heart of the patient.

The left and right sections of the stabilization arm clamp 162 on thesled member 140 are configured so as to form a through aperture 164therein. This aperture 164 is preferably offset from the rotational orhorizontal axis of the knob 160 and threaded rod 170 to increase ordecrease the angle of approach of the handle segment 180 to theoperative field. As shown, the preferred configuration orients theaperture 164 above the rotational axis of the knob 160. If desired bythe surgeon, the aperture 164 and therefore the handle segment 180 maybe positioned below the rotational axis of the knob so that the handlesegment will approach the operative field at a lower angle. The aperture164 slidably and rotationally receives the handle segment 180 of thestabilization arm 104 therein. The stabilization arm clamp 162 isrotatably disposed about the threaded rod 170 to allow the handlesegment to be rotatable about the longitudinal axis of the threaded rod170 as well as being separately rotatable and slidable with respect tothe aperture 164. The rotational surfaces between the stabilization armclamp 162 and the sled pin clamp 166 may also preferably have aplurality of complementary ridges and valleys thereon so as to form apoker chip type surface on each of these surfaces of the clamps. The useof this type of surface preferably limits the rotational movement of thestabilization arm clamp 162 with respect to the sled pin clamp 166 whenthe knob 160 and threaded rod 170 are intermediately or fully tightenedby providing an additional source of friction that must be overcome torotate the handle segment with respect to the stabilization arm clamp162. Additionally, the use of this type of surface facilitates the finepositioning of the stabilization device 106 by preventing the rotationalmovement of the stabilization arm clamp 162 while the surgeon is stillable to overcome the frictional resistance to the rotational and slidingmovement the handle segment 180 when the knob 160 is not fullytightened.

The preferred form of the present invention also includes the threadedrod 170 that is fixedly attached to the knob 160 and extends between theknob 160 and the outer section 167 of the sled pin clamp 166. In thisway, and as described hereinafter, the stabilization arm clamp 162 andthus the handle segment 180 of the stabilization arm 104 can be rotatedby the surgeon about the threaded rod 170 prior to the knob 160 beingrotated to a fully engaged position wherein relative movement isprevented. Additionally, the handle segment 180 may also slide and/or berotated with respect to the stabilization arm clamp 162 through theaperture 164 to facilitate positioning of the stabilization device 106through the manipulation of an actuation member such as the single knobdescribed herein or through a single lever or handle.

The knob 160 is secured to one end of the threaded rod 170 and the otherend of the rod engages the outer section 167 of the sled pin clamp 166.The sled pin clamp 166 and the stabilization arm clamp 162 are eachlocated rotationally about the threaded rod 170 and are compressivelycontrolled thereby. Thus, rotation of the knob 160 in one direction(e.g., clockwise direction) moves the left and right sections of each ofthese clamps towards each other (i.e., compresses the clamps) so as toclamp onto each of the sled pin 158 and the handle segment 180respectively. The compression of the sled pin 158 by the sled pin clamp166 limits the rotational movement of the bottom section of the sledmember 140 with respect to the upper section of the sled member 140 tolimit the generally horizontal movement of the stabilization arm 104with respect to the retractor 102. The compression of the handle segment180 by the stabilization clamp 162 prevents the rotational and slidingmovement of the handle segment 180 through the aperture 164 andtherefore causes the stabilization device 106 to be held in a fixedposition relative to the sled member 140 and the retractor 102 to limitthe generally vertical movement of the stabilization arm 104 withrespect to the retractor 102. Similarly, rotational movement between thestabilization arm clamp 162 and the sled pin clamp 166 is limited bytightening the knob 160 to a fally engaged position. Rotation of theknob in the opposite direction (e.g., counterclockwise direction) causeseach of these clamps 162 and 166 to separate and enable the clamps to berotatable about the sled pin 158 and/or the threaded rod 170. In thepreferred form of the present invention, each of the clamps include aspring member (not shown) therein to facilitate the separation of theclamps as the knob is rotated in this position. Additionally, the handlesegment 180 can slide and rotate within the stabilizer arm clamp 162 andthrough the aperture 164. As one skilled in the art would appreciate,the knob 160 can be rotated in the direction of clamping so as toincrease the resistance of rotation about the sled pin 158 and toincrease the resistance to sliding and/or rotation of the handle segment180 in the aperture, without completely preventing such rotation and/orsliding. This may be done to facilitate the precise positioning of thestabilization device 106 by the surgeon. Additionally, the clamps 162and 166 may be arranged so that the initial rotation of the knob 184 mayfirst release either the sled pin 158 or the handle segment 180 prior tothe release of the other of the sled pin 158 or handle segment 180.Additionally, the clamps 162 and 166 may be arranged to initially allowfor or prevent the rotation of the stabilization arm clamp 162 relativeto the sled pin clamp 166. Thereafter, the clamps 162 or 166 may releasethe sled pin 158 and handle segment 180 at the same time orsequentially. Although the preferred form of the present invention isdescribed herein as a knob, it is anticipated that a lever or similaractuation member may be used to accomplish the desired, orientation ofthe stabilization device 106 relative to the retractor 102.

In an alternate embodiment of the present invention, the bottom surfaceof each of the first and second arms, 112 and 116, on the retractor 102include removable sternal blades 210 attached thereto. Each blade 210 isremovable so as to facilitate the use of the retractor in a full ormini-sternotomy procedure by allowing for the selective positioning andspacing of the blades 210 as desired for the particular procedure aswell as for increasing the ease of use of the retractor 102 and blades210. As illustrated, the blades 210 of this embodiment are positionedalong the bottom surface of the arms 112 and 116 and are preferablyformed to include one or more downwardly extending blade elements 220which are attached to the base sections on each arm of the retractor. Aswith the prior embodiment, the blades are preferably slightly pivotal inthe horizontal and vertical directions with respect to the arms. Forexample, the blades 210 may preferably pivot up to about thirty degreesin the horizontal direction and slightly or not at all in the verticaldirection. The blades 210 are slidable into elongate ridged slots 132 onthe bottom surface of the first and second arms, 112 and 116. The blades210 may also swivel a limited distance and are selectively positioned inthe slots 132 so as to evenly distribute the retraction forces orpressure along the contour of the sternum of the patient. An upper orbase section 212 of each blade 210 is particularly configured tofacilitate the insertion of the blades into the retractor. Inparticular, the upper surface 214 of the base section 212 of the blade210 is configured so that an upward extending and generally oblongshaped lip member 216 is received in the ridged slots 132 located on thebottom surface of the first and second arms, 112 and 116. This uppersurface 214 further includes a raised ball member 218 which slides in afurther slot 139 located in the ridged slots. The ball member 218 may beslightly depressible so that it may be slid beyond the further slot 139so that during the initial placement of the retractor, the blades 210may be positioned to extend nearly linearly along each arm in aninsertion position. The use of the ball member and the ridged slotsallow the blades to temporarily assume the linear configuration and alsorise slightly to provide a lower profile and maintain the retractionedge.

As shown in FIGS. 14-16, the base section 212 of the blades 210 of thisembodiment may include one or more blade elements 220 that extendinwardly and downwardly from the base section 212. As described, thebase sections 212 preferably include a single oblong lip member 216 onthe upper surface 214 thereof and two or three blade elements 220extending inwardly and downwardly therefrom. Additionally, the bladeelements 220 are preferably configured to provide a nested, alternatingor interlocking arrangement when the arms of the retractor are in theclosed position. The blade elements 220 preferably include a firstsection 222 that extends inwardly from the base section 212. As shown,the blade elements 220 on the first section 222 preferably nest with thecomplementary blade elements of the first section from the blade 210 onthe opposite arm of the retractor. The second section 224 of the bladeelements 220 are preferably inwardly and downwardly curved at an angleof about 180 degrees. The second section 224 of the blade elements 220extend downwardly from the first section 222 beginning at theapproximate midpoint of the inner surface of the arms of the retractor.The third section 226 of the blade elements 226 are preferably straightand extend downwardly from the second section 224 and provide a gradualtransition between the straight third section and the curved secondsection. As shown, the third section 226 is preferably aligned with theinner surface of the arms of the retractor when the arms are in theclosed position.

The surgeon initially makes a long incision down the middle of thechest, saws through the sternum, spreads the two halves of the sternumapart using the blades 210 of the surgical retractor. Initially, thearms of the retractor are in the closed position so the blades 210 arein the nested orientation wherein the blade elements 220 on each arm aregenerally linearly aligned. The surgeon initially places the thirdsection of the blades into the incision. The surgeon then beginsspreading the arms while pressing down on the retractor, this motioncauses the tissue of the patient to contact and engage the secondsection of the blades so that the tissue is received along the innersurface of the curved portion of the second section of the bladeelements. Additionally, as the blade elements 220 are inserted into thesternum, the slight release of the pressure during the insertion allowsthe ball member 218 to return to the innermost end of the further slotand the blade elements 220 may pivot slightly in the vertical andhorizontal directions so that the blades 210 provide optimum leverage toretract the sternum of the patient. As the distance between the arms isincreased, the curvature of the second section 224 engages and retainsthe tissue along the sternum of the patient to provide secure and stableretraction of the sternum of the patient.

The use of the stabilization system 100 according to the preferredaspect of the present invention can be best understood from thefollowing discussion with reference to the drawings. Although thefollowing discussion makes reference to the use of the stabilizationsystem specifically in connection with a coronary artery bypass graftinga-surgical procedure, the use of the stabilization system of the presentinvention is not limited to such uses.

After appropriately preparing and positioning the patient for thesurgical procedure and completing those actions required in advance ofthe use of the stabilization system, the arms 112 and 116 of theretractor 102 would be closed such that the upper portion 134 of theblades 130 or the third section 226 of the blades 210 are generallyabutting each other. The surgeon then positions the lower sections 138or third sections 226 of each of the blades adjacent to the incision andpushes down on the retractor or otherwise manipulates the blades and thepatient so the blades are pushed through the incision and past thesternum as described above. Thereafter, as the arms of the retractor areseparated, the blade elements pull the chest of the patient open toprovide the desired surgical area.

After inserting the retractor, the surgeon displaces the two retractorarm segments 112,116 with respect to each other by rotating the handle118 on the second arm segment 116. As the surgeon opens the sternum ofthe patient, they also release any underlying connective tissue and openthe pericardium surrounding the heart of the patient. In order toprovide for visualization of the heart, the pericardium that surroundsthe heart is retracted by placing sutures (not shown) through thepericardium and then threading the sutures through the slots 123 on theretractor arms to ensure that the sutures are spaced apart from theoperative field. As mentioned above, the clamps (not shown) holding thesutures may then be positioned in the slots so that the distal end ofthe clamping instrument is positioned in the through holes 124. Thisallows the sutures and clamps to be positioned out of the way of thesurgeon for the subsequent procedure. After performing any subsequentactions to further open the sternum of the patient to create the desiredfield of view and assess the viability of the heart to perform thebypass grafting procedure on one or more vessels, the surgeon mounts thestabilization arm 104 onto one of the retractor arm segments 112,116 orthe rack segment 114 in the position that they anticipate will providethe best access while minimizing the obstruction of their view for theparticular procedure.

It should be recognized that the bypass grafting procedure may involvethe arteries or branches thereof on nearly any surface of the heartincluding the posterior or backside of the heart. Therefore, having thecapability to mount the stabilization arm to the rack segment 114 oreither of the arms, 112 or 116, of the retractor can be particularlyadvantageous. With the preferred form of the present invention, thestabilization arm 104 may be positioned near the top of the operativefield on the rack segment 114 rather than only along the sides of theoperative field. The retractor 102 is typically arranged on the body sothe throat of the retractor faces the head of the patient and thesurgeon is typically located on one side of the patient while a nurse islocated on the other side of the patient and instruments are passedacross the body of the patient throughout the procedure. Therefore, withthe preferred form of the present invention, the surgeon has anadditional surface to choose from when they are deciding which surfacewill provide the best access to the desired surface of the heart whilenot interfering with the procedure.

To mount the stabilization arm 104 onto the retractor 102, the surgeonrotates the sled actuator lever 154 so the second lip 152 is in adisengaged position and is spaced from the front edge lip 150 of thesled member 140. After so configuring the sled member 140, the surgeonpositions the sled member 140 on the retractor 102 at any of a number ofavailable positions on the arms, 112 and 116, or the rack segment 114 bypositioning the front edge lip 150 over the front edge of the selectedarm or rack segment. With the preferred configuration of the sled member140, the surgeon need not slide the sled member along the entire lengthof a retractor arm or be required to select from a limited number ofpredetermined positions, but can place the sled member 140 directly atthe desired position. In this way, a surgeon can removably position thesled member 140 anywhere on the rack segment 114 or the arms 112, 116 ofthe retractor 102 without having to first assemble the retractor with asled member 140 initially positioned in any of these predefined areas.An advantage of this configuration is that the surgeon may initiallyposition the sled member 140 in a position that they anticipate will beclose to where they will ultimately want it. If during the procedure, adifferent location is needed or provides better access, the surgeon mayeither slide the sled member 140 along the previously selected arm orrack segment to the desired location or they may remove the sled member140 from the retractor and try various locations to see which locationon the arms and rack segment provides the best access for the particularprocedure. In addition, such a sled configuration also allows thesurgeon to perform certain surgical procedures without having to worryabout the sled member 140 cutting or interfering with any sutures thatmay be passing over the retractor while positioning the sled member 140.Furthermore, if multiple blood vessels are operated on or access tomultiple surfaces is desired, the orientation of the sled member may bereadily adjusted to accommodate the needs of the particular part of theprocedure.

The surgeon may next fix the sled member in place by positioning thefront edge lip 150 of the sled member 140 over the front edge surface120 a, 120 b or 120 c on the desired area of the retractor 102 and thenrotating the sled actuator lever 154 partially or fully, as desired, sothe second lip 152 contacts and engages the vertical extending surfaceof the corresponding step surface 122 a-c on the retractor 102. Onesurgeon has placed the sled member on the retractor, they may theninitially position the stabilization device 106 near the ultimatedesired location along the surface of the heart by loosening the movableknob 184 and rotating the fixed knob 186 as well as loosening the knob160 on the sled member to orient the stabilization device 106 andstabilization arm 104 in the tentative desired position. It should berecognized that this process may be repeated as often and whenevernecessary to modify the position of the stabilization device 106 at thedesired location or area of the heart.

Thereafter, the surgeon may loosen knob 160 and rotate the top sectionof the sled member 140 about the sled pin 158 and also move the handlesegment 180 lengthwise and/or rotationally with respect to the sledmember 140 to position the handle segment within the stabilization arm162 clamp through aperture 164 so as to position the stabilizationdevice 106 with respect to the predetermined area of the heart to bestabilized. Once the surgeon is satisfied with the location of thestabilization device 106 on the heart of the patient, the surgeon maytighten knobs 160 and 184 to ensure that the stabilization arm 104 andstabilization device 106 are retained in the desired position throughoutthe remainder of the procedure. Once the stabilization device 106 is inthe desired contacting relationship with the predetermined area of theheart, the surgeon may tighten the knob 160 of the stabilization arm 140so as to prevent further rotation about the threaded rod and the sledpin and also to prevent sliding of the handle segment in the aperture.The surgeon may also tighten the knob 184 of the handle segment 180 soas to tighten the connection between the distal connector 181 on thehandle segment and the post member 196 on the stabilization device 106prevent further motion of the stabilization device 106 about the end ofthe stabilization arm 104.

After completing the grafting procedure, the surgeon may then remove thestabilization arm 104 and stabilization device 106 by essentiallyreversing the above described steps or the surgeon may simply releasethe actuator lever 154 and remove the entire stabilization arm andstabilization device from the operative field. Similarly, the actuatorlever may be moved to a position between the engaged and disengagedpositions so that the stabilization arm may be moved out of the waywhile a subsequent procedure is performed or to attach a newstabilization device thereon.

In the foregoing discussion, the stabilization system of the presentinvention is described in terms of clamping and supporting astabilization device. It is within the scope of the present invention,however, for the system to be configured to removably secure any of anumber of surgical instrumentalities to the retractor such as forexample diaphragm or valve retractors. Additionally, although onestabilization arm is described as being in use at a time, it is withinthe scope of the present invention for plurality or a multiplicity ofstabilization arms to be secured to the retractor. For example, onestabilization arm could be provided to support a diaphragm retractor andanother stabilization arm provided to support a tissue stabilizer orsuction device. Furthermore, the blade elements described above may beattached to the retractor arms using a variety of attachmentconfigurations and may include one or more blade elements extendingtherefrom that are arranged in a variety of configurations that may beused to assist in the retraction of the chest or similar tissue of thepatient.

Although a preferred embodiment of the invention has been describedusing specific terms, such description is for illustrative purposesonly, and it is to be understood that changes and variations may be madewithout departing from the spirit or scope of the following claims.

What is claimed is:
 1. A system for use in a surgical procedure,comprising: a retractor having a plurality of retractor arms thereon anda segment interconnecting said retractor arms wherein said retractorarms are movable with respect to each other and include top and bottomsurfaces thereon wherein said bottom surface of each of said armsincludes a plurality of elongate slots having a blade engaging surfaceon said bottom surface of said arms; and a plurality of blades eachhaving an upper surface with a raised surface thereon and said uppersurface of said blades being sized to be slidably contacting with saidblade engaging surface of said slot to allow horizontal movementtherebetween and said blades further having at least one downwardlyextending blade element thereon.
 2. The system of claim 1 wherein eachof said plurality of blades are slidable into one of said slots and saidblades are spaced apart from said top surface of said arms.
 3. Thesystem of claim 1 wherein at least one of said blades include a thirdsection thereon that is curved relative to first and section sectionsthereof.
 4. The system of claim 3 wherein said first section of said atleast one of said blades is oriented generally perpendicular to saidthird section of said blade element.
 5. The system of claim 3 whereinsaid first section of said at least one of said blades is orientedgenerally parallel to said top surface of at least one of said retractorarms of said retractor.
 6. The system of claim 3 wherein each of saidretractor arms include inner surfaces and said third section of said atleast one of said blades is generally aligned with the inner surface ofthe retractor arms.
 7. The system of claim 6 wherein said second sectionof said at least one of said blades includes an inner and outer surfaceand said second section extends outwardly beyond the inner surface of atleast one of the retractor arms.
 8. The system of claim 3 wherein secondsection of said at least one of said blades has an angle of curvature ofapproximately 180 degrees.
 9. A system for use in a surgical procedure,comprising: a retractor having a plurality of retractor arms thereon anda segment interconnecting said retractor arms wherein said retractorarms are movable with respect to each other and include top and bottomsurfaces thereon wherein said bottom surface includes a blade engagingsurface on said bottom surface of said arms; a plurality of blades eachhaving an upper surface with a raised surface thereon and said uppersurface of said blades being sized to be slidably contacting with saidblade engaging surface to allow horizontal movement therebetween andsaid blades further having at least one downwardly extending bladeelement thereon; and wherein said blade engaging surface on said bottomsurface of said arms include a plurality of ridged slots and a pluralityof further slots are located in said ridged slots and said bladesfurther include a raised member thereon which is sized to be in slidablecontact with said further slots.
 10. The system of claim 9 wherein saidraised member includes a ball member that extends upwardly with respectto said upper surface of each of said blades.
 11. A blade member for useon surgical retractors, said blade member including: a body sectionhaving an upper surface and said upper surface of said body sectionhaving a member thereon that is sized to slidably contact an arm of asurgical retractor and said member is depressible relative to said uppersurface of said body section upon contact with an arm of a surgicalretractor; and a blade element extending from said body section and saidblade element having a first section and a second section wherein thesecond section is curved relative to the first section and said secondsection extends downwardly therefrom.
 12. The blade member of claim 11wherein said member includes a ball member associated therewith.
 13. Theblade member of claim 11 wherein said body section includes a lip memberextending along the periphery thereof.
 14. The blade member of claim 11wherein said body section generally includes an oblong member having alip surface extending along the periphery thereof.
 15. The blade memberof claim 11 wherein said blade element further includes a third sectionextending generally downwardly from said second section and said thirdsection is oriented generally perpendicular to said first section.16.The blade member of claim 15 wherein said second section includes anangle of curvature of about 180 degrees.
 17. The blade member of claim11 wherein said body section includes at least two spaced apart bladeelements extending downwardly therefrom and said blade elements areconfigured relative to each other to align with blade elements from anadditional blade member.
 18. The blade member of claim 11 wherein saidfirst section is generally aligned with said body section and saidsecond section curves downwardly relative to said first section.
 19. Asystem for use in a surgical procedure, comprising: a retractor having aplurality of retractor arms thereon and a segment interconnecting saidretractor arms wherein said retractor arms are movable with respect toeach other and top and bottom surfaces thereon wherein said bottomsurface includes a plurality of ridged slots on said bottom surface ofsaid arms; and a plurality of blades at least one of which has an uppersurface with a raised surface thereon and said upper surface of said atleast one of said blades being sized to be in slidable contact with atleast one of said ridged slots to allow horizontal movement therebetweenand said at least one of said blades further having at least onedownwardly extending blade element thereon; a ball member that extendsupwardly with respect to said raised member; a blade element associatedwith said upper surface of said at least one of said blades and saidblade element including a first section that is oriented generallyparallel to at least one of the arms of the retractor; a second sectionon said blade element wherein said second section includes a downwardcurve extending from said first section; a third section on said bladeelement wherein said third section extends downwardly from said secondsection and is oriented generally perpendicularly to said first section;and wherein each of said retractor arms include inner surfaces and saidthird section of said blade elements are generally aligned with theinner surface of at least one of the retractor arms and said secondsection extends beyond said inner surface of at least one of saidretractor arms.